| NPI | 1588963839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A131410) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.133539) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2016-07-19 |