| NPI | 1578658993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-096278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 22369) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 40524) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: IL 036-096278) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-11-30 |