| NPI | 1063864734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036150563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 88-321) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2025-07-03 |