| NPI | 1033777032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-161722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.074507) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-08-24 |