| NPI | 1205833860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 04772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036104146) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2017-03-13 |