| NPI | 1760485007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036094325) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 37594) |
| 207Q00000X Family Medicine (Licence: WI 37594) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2020-10-13 |