NPI | 1043552862 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 60660929) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138919) |
Enumeration Date | 2013-03-19 |
Last Update Date | 2019-07-10 |