| NPI | 1104209931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036145477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125067860) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2018-07-03 |