| NPI | 1710916986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60242443) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036080295) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2014-02-05 |