| NPI | 1568422806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036104222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 33372) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-10-13 |