| NPI | 1295709657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 28887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036088325) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2016-07-14 |