| NPI | 1265797021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.138490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-062008) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2023-08-03 |