NPI | 1467832683 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D85981) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-067044) |
Enumeration Date | 2015-06-03 |
Last Update Date | 2018-08-29 |