| NPI | 1710204706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.144014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.206253) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2017-11-08 |