| NPI | 1477822955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125056713) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 8247212-1204) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2012-04-30 |