| NPI | 1508150863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 74627) |
| Enumeration Date | 2011-06-04 |
| Last Update Date | 2023-11-27 |