NPI | 1306379268 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.152175) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301118947) |
Enumeration Date | 2017-04-07 |
Last Update Date | 2025-09-16 |