| NPI | 1356722151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036145532) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067637) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2020-04-29 |