| NPI | 1316113954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036-047434) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C50725) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2008-05-06 |