NPI | 1033841374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.174584) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2022-0808) |
Enumeration Date | 2022-06-27 |
Last Update Date | 2025-07-29 |