| NPI | 1417021882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-065108) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 25281) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-11-05 |