| NPI | 1851353247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 2005036219) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A18065) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2022-09-23 |