| NPI | 1902034168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A123347) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125056221) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2013-05-02 |