| NPI | 1477539211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101274840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 36102725) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: IL 36102725) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-10-19 |