| NPI | 1275680258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036098945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 16884) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-12-16 |