| NPI | 1508423518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.162302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME158741) |
| 207Q00000X Family Medicine (Licence: FL TRN28772) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2024-08-23 |