| NPI | 1073839833 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 193400000X Single Specialty (Licence: MD D814945)  | 
| Additional Taxonomies | 2086S0129X  (Licence: IL 125059828)  | 
| Enumeration Date | 2010-04-19 | 
| Last Update Date | 2017-01-27 |