| NPI | 1053403915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009012802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036099983) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2014-09-09 |