| NPI | 1174962500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036139504) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2016-09-01 |