| NPI | 1639205255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G131027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036085370) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2015-11-11 |