| NPI | 1720051972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036104811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2001010361) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2016-05-16 |