| NPI | 1962150888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036181047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL61428982) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2026-07-14 |