| NPI | 1053527184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.126315) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A107917) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2015-10-19 |