| NPI | 1972671923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-106943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 48596) |
| 207Q00000X Family Medicine (Licence: IL 036106943) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2024-02-09 |