| NPI | 1497104335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-147485) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 70533-20) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-07-24 |