| NPI | 1114934882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: IL 0360785701) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 0360785701) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-09-11 |