NPI | 1538110960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-108107) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45217) |
207Q00000X Family Medicine (Licence: IA 34949) | |
Enumeration Date | 2006-05-12 |
Last Update Date | 2017-01-09 |