| NPI | 1336221613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MT 11272) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036-057039) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2010-11-29 |