| NPI | 1447944996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.082451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 76265) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2026-06-14 |