| NPI | 1154841807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 22602) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-02-23 |