| NPI | 1487949467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.135777) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2020-11-19 |