NPI | 1184129132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.153489) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072802) |
Enumeration Date | 2018-03-29 |
Last Update Date | 2021-12-06 |