| NPI | 1760831648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101022304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036150574) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-11-19 |