NPI | 1114019049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO T2006017510) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036123174) |
207Q00000X Family Medicine (Licence: WA MD61380771) | |
Enumeration Date | 2006-09-28 |
Last Update Date | 2024-02-12 |