| NPI | 1396899852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203089) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.117047) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2012-10-25 |