| NPI | 1598074353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010019755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036141680) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2026-04-16 |