| NPI | 1508973918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.061328) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036061328) |
| 208D00000X General Practice (Licence: MO R2F64) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2015-10-23 |