NPI | 1154841807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036151634) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 22602) |
Enumeration Date | 2017-06-23 |
Last Update Date | 2023-02-23 |