| NPI | 1568782761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 47144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125058266) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2016-06-15 |