| NPI | 1891959086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.126517) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.126517) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2011-02-14 |