| NPI | 1295704674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 23849) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036070172) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-04-29 |