| NPI | 1134483233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036168074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60584261) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2025-07-31 |