| NPI | 1770824112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036031368) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 2743730) |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2013-03-11 |