| NPI | 1518036979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.139552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R4F20) |
| 333600000X Pharmacy (Licence: MO R4F20) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-01-21 |