NPI | 1790804136 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036123810) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301085634) |
Enumeration Date | 2007-03-28 |
Last Update Date | 2020-01-24 |