| NPI | 1184129132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.153489) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072802) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2021-12-06 |