| NPI | 1194764860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036100744) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD456697) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-10-13 |