| NPI | 1053364349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036115945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 54638-20) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-01-12 |