| NPI | 1093078420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 1724) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-136190) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-06-02 |