| NPI | 1740228840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036096215) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3419) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-05-04 |