| NPI | 1750461208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036067298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 23679) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2008-01-18 |