| NPI | 1952614893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036126938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125055097) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2019-12-27 |