NPI | 1780082693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206019) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-144866) |
Enumeration Date | 2014-12-09 |
Last Update Date | 2024-05-14 |