NPI | 1003229402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A143988) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036142833) |
207Q00000X Family Medicine (Licence: PA MT206848) | |
Enumeration Date | 2014-06-04 |
Last Update Date | 2022-08-01 |