NPI | 1053706309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16396) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125066917) |
390200000X Student in an Organized Health Care Education/Training Program | |
207Q00000X Family Medicine (Licence: IL 036.146095) | |
Enumeration Date | 2015-04-03 |
Last Update Date | 2021-11-05 |