| NPI | 1497097141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70163) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.139017) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2018-11-05 |