| NPI | 1750734612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 1748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036150733) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2023-08-02 |