| NPI | 1508516865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 036172742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.080694) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-08-27 |