| NPI | 1740299759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-110615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004010997) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2016-05-19 |