NPI | 1114284411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35134072) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036138589) |
Enumeration Date | 2012-04-12 |
Last Update Date | 2020-05-13 |