NPI | 1770932204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036.147296) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.068516) |
Enumeration Date | 2016-06-06 |
Last Update Date | 2024-05-01 |