| NPI | 1275775165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO1346) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.122210) |
| 207Q00000X Family Medicine (Licence: VA 0102202301) | |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2014-02-18 |