| NPI | 1972733103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-131428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301095255) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2025-03-20 |