| NPI | 1356962740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036172116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 75001) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-12-17 |