| NPI | 1194912220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036086944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 51172-20) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2019-06-21 |