| NPI | 1891992269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036124188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56981) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2014-10-06 |