| NPI | 1790920981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 36-2169147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.054756) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2021-12-28 |