| NPI | 1013411305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.172020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 59921) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-12-09 |