| NPI | 1851399976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036111331) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2004014269) |
| 207Q00000X Family Medicine (Licence: IL 2004014269) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-01-19 |