| NPI | 1407166648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036129324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125056913) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2012-09-13 |