| NPI | 1881715480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036104492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44348-020) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2013-03-26 |