| NPI | 1194771840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-107472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 34196) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-06-26 |