| NPI | 1003135377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036132513) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 147954) |
| 207Q00000X Family Medicine (Licence: MD D0096374) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2024-12-17 |