| NPI | 1508072620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036119343) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2013-01023) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-07-21 |