| NPI | 1174735302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28648) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-049880) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-08-20 |