NPI | 1932580230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036159358) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301108007) |
207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301108007) | |
Enumeration Date | 2015-06-11 |
Last Update Date | 2022-08-05 |