NPI | 1366973786 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.162871) |
Additional Taxonomies | 208D00000X General Practice (Licence: WI 71890-20) |
208D00000X General Practice (Licence: GA 87237) | |
Enumeration Date | 2017-03-27 |
Last Update Date | 2023-08-22 |