| NPI | 1245496496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036128765) |
| Additional Taxonomies | 2086S0129X (Licence: KY TP786) |
| 208D00000X General Practice (Licence: IA MD-44392) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2023-11-24 |