| NPI | 1396766937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 24314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-079295) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-02-15 |