| NPI | 1962573626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-082935) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-01-27 |