| NPI | 1023099256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.126628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A8952) |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2023-11-06 |