| NPI | 1992111009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036141987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125065174) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2020-05-01 |