| NPI | 1710618566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 125.080959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.080959) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-07-06 |