| NPI | 1891004404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125056495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036129113) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2023-08-18 |