| NPI | 1164455978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036112300) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 45398-020) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2016-09-08 |