| NPI | 1487987814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-141804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD446474) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2018-09-24 |