| NPI | 1023272812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 1336) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036129583) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2023-06-12 |