| NPI | 1255350666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD62777) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-066566) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-09-21 |