| NPI | 1770725202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4061) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.053253) |
| 207Q00000X Family Medicine (Licence: IL 036.123879) | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2014-04-30 |