| NPI | 1114319852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036161805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073658) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-04-17 |