| NPI | 1114367356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.1411045) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL12778) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2026-04-14 |