| NPI | 1801460746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.167255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.078175) |
| Enumeration Date | 2021-05-15 |
| Last Update Date | 2024-08-28 |