| NPI | 1821583964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.156087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073378) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2021-07-02 |