| NPI | 1083660229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036102939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018552) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-08-24 |