| NPI | 1205965787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.117179) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: IL 036.117179) |
| 207P00000X Emergency Medicine (Licence: IL 036.117179) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2013-08-12 |