| NPI | 1053623330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.132875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012030856) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2013-08-08 |