| NPI | 1275049066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.062886) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036.062886) |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2021-06-14 |