| NPI | 1720120462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.121717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036127171) |
| 207Q00000X Family Medicine (Licence: OK 24447) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-06-01 |