| NPI | 1619282233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.132207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125057692) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2021-07-29 |