| NPI | 1679004956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 22793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036153145) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-11-16 |