| NPI | 1023372349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15872) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.136108) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2021-12-17 |