| NPI | 1154317295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70754-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036112131) |
| 207Q00000X Family Medicine (Licence: IL 036-112131) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2020-11-17 |