NPI | 1376540559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036135207) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 110832) |
207Q00000X Family Medicine (Licence: SC 87780) | |
Enumeration Date | 2005-07-04 |
Last Update Date | 2024-09-18 |