| NPI | 1225038276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036092084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 40031-20) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2023-11-02 |