| NPI | 1063553543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036113596) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2017-05-01 |