| NPI | 1912219478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036152142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-8170) |
| 207Q00000X Family Medicine (Licence: AR t2013-064) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2025-09-08 |