| NPI | 1164082533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036171236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 05361) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-07-25 |