| NPI | 1104811058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-114490) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IL 036-114490) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-02-23 |