| NPI | 1972524403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-114345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006018405) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-05-23 |