| NPI | 1508291790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036140597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 954-320) |
| 207Q00000X Family Medicine (Licence: MI EMC0000119) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2024-01-03 |