| NPI | 1528053212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 20937) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 036-106738) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-11-10 |