| NPI | 1710365358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036147880) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301107174) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2021-12-03 |