| NPI | 1669237103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IL 1215204) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-10-22 |