| NPI | 1992217178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2017033642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036157152) |
| Enumeration Date | 2017-10-28 |
| Last Update Date | 2024-06-21 |