NPI | 1124551809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 56913) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.075298) |
Enumeration Date | 2017-04-09 |
Last Update Date | 2023-09-15 |