| NPI | 1003545211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.172262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME175947) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-08-20 |