NPI | 1003044421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 824) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-056918) |
Enumeration Date | 2009-06-24 |
Last Update Date | 2023-08-14 |