| NPI | 1326297987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125053752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.30618) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2017-11-21 |