| NPI | 1003256975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036139695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66349-20) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2026-03-19 |