| NPI | 1790804136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036123810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301085634) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-01-24 |