NPI | 1366542763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 195031) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036060973) |
Enumeration Date | 2006-09-25 |
Last Update Date | 2014-11-20 |