NPI | 1780116848 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 192306) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125071432) |
Enumeration Date | 2017-03-29 |
Last Update Date | 2023-12-14 |