| NPI | 1518909977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-094345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036094345) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2011-09-01 |