| NPI | 1932377249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.119375) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008004462) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2009-05-05 |