| NPI | 1508092305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD21922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.056362) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: IL 036-128551) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036-128551) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2018-04-26 |