| NPI | 1285196725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO213666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073621) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2023-05-25 |