| NPI | 1558526566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.119229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 61649) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2021-10-06 |