| NPI | 1003028143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036120810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 51956-020) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-08-27 |