| NPI | 1376834804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.167751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9039274-1205) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2024-03-14 |