| NPI | 1285074153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 84778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036140962) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-06-07 |