| NPI | 1508423054 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.081994) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101025890) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2024-09-15 |