| NPI | 1780116848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 192306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071432) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-04-28 |