NPI | 1639799109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: IL 036.164104) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A176759) |
207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: IL 036.164104) | |
208D00000X General Practice (Licence: CA A176759) | |
Enumeration Date | 2020-04-24 |
Last Update Date | 2024-10-15 |