| NPI | 1164548046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-047948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-047948) |
| 207Q00000X Family Medicine (Licence: WI 18888) | |
| 208600000X Surgery (Licence: WI 18888) | |
| 208D00000X General Practice (Licence: IL 036-047948) | |
| 207R00000X Internal Medicine (Licence: IL 036-047948) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: IL 036-047948) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-09-26 |