| NPI | 1538415518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036157171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-42011) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2021-10-06 |