| NPI | 1902890296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55124) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA C55124) |
| 207Q00000X Family Medicine (Licence: IL 036095111) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2018-03-17 |