| NPI | 1952307407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 31912) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036098911) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2021-04-30 |