| NPI | 1932149416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036114884) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53476) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-09-27 |