| NPI | 1093709057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036118309) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023012237) |
| 207Q00000X Family Medicine (Licence: IA 35234) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2023-10-25 |