| NPI | 1912246851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A12119) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036114864) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2014-08-04 |