| NPI | 1376540559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036135207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 110832) |
| 207Q00000X Family Medicine (Licence: SC 87780) | |
| Enumeration Date | 2005-07-04 |
| Last Update Date | 2024-09-18 |