| NPI | 1356781512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 16528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125062539) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2020-01-05 |