| NPI | 1831149228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-116809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41607) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2012-07-07 |