| NPI | 1467982108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.161353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125071318) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-25 |