| NPI | 1063874410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036176697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 320635) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2025-08-20 |