| NPI | 1366973786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.162871) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 71890-20) |
| 208D00000X General Practice (Licence: GA 87237) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-08-22 |