NPI | 1184894859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 076590) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245670) |
207Q00000X Family Medicine (Licence: IL 036.119478) | |
Enumeration Date | 2008-03-09 |
Last Update Date | 2022-01-10 |