| NPI | 1124434477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-157495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66578) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-10-17 |