| NPI | 1376577825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017029652) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-115521) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2026-07-21 |