| NPI | 1730618927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD210691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.150689) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2026-01-21 |