| NPI | 1487089645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 085004806) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.004806) |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2021-08-10 |