| NPI | 1982167110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036172314) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2024-12-20 |