| NPI | 1982695151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036097517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 26375) |
| 207Q00000X Family Medicine (Licence: MO 103110) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-02-23 |