| NPI | 1205092806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125053792) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2022-09-24 |