| NPI | 1821022450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036063179) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 212881-1) |
| 207Q00000X Family Medicine (Licence: GA 036515) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |