| NPI | 1861481244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036376054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28756020) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2014-09-02 |