| NPI | 1063659928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OT012311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.126214) |
| 207Q00000X Family Medicine (Licence: PA OS014690) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2010-09-15 |