| NPI | 1770974776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 284089) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125070518) |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2020-09-23 |