| NPI | 1740215854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53538) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036094748) |
| 207V00000X Obstetrics & Gynecology (Licence: IL 036094748) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-03-13 |