| NPI | 1225158728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-124689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD436189) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2017-03-24 |