| NPI | 1306853221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101009532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-087287) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2012-11-10 |