| NPI | 1255648010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD158367) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036.171205) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2025-04-25 |