| NPI | 1912992140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101172) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 336072558) |
| 207Q00000X Family Medicine (Licence: KS T-01043) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2014-08-29 |