| NPI | 1891133005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO2058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036144687) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2018-09-18 |