| NPI | 1508913534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036085397) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME71579) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-06-30 |