NPI | 1154674877 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 144514) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125060127) |
Enumeration Date | 2012-10-18 |
Last Update Date | 2018-05-08 |