| NPI | 1659635092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-136456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125062270) |
| 207Q00000X Family Medicine (Licence: WI 64214-20) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2024-07-25 |