| NPI | 1437132479 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12703)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036081072)  | 
| Enumeration Date | 2005-11-23 | 
| Last Update Date | 2015-06-09 |