| NPI | 1881705564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2001019992) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036105498) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-07-22 |