NPI | 1568783413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61030-20) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125057627) |
Enumeration Date | 2010-06-15 |
Last Update Date | 2013-08-02 |