| NPI | 1669092938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.161912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075615) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-02-20 |