| NPI | 1659536852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.130480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P1265) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-11-05 |