| NPI | 1598285884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125-070183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125070183) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |