| NPI | 1154995223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301512210) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125077990) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2024-09-26 |