| NPI | 1386677128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.077712) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 102900) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-06-14 |