| NPI | 1033633573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-174963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD470142) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2025-08-15 |