| NPI | 1245315019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 37768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-113925) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2014-03-28 |