| NPI | 1821066879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036091978) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 26132) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2007-07-08 |