| NPI | 1992118624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.147760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-09912) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2018-11-29 |