| NPI | 1215194733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C133356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.125307) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2016-10-11 |