| NPI | 1023042470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 003-036-082187-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 38607) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-01-12 |