| NPI | 1164445854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036116087) |
| Additional Taxonomies | 202K00000X (Licence: IL 036116087) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-02-09 |