| NPI | 1679569511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101268285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-109694) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2020-07-20 |