| NPI | 1932513272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036162228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301105812) |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2023-04-06 |