| NPI | 1407962012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.086462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036086462) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2014-01-23 |