| 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 |