| NPI | 1982845814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 336.012858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.046255) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |