NPI | 1619237856 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60994911) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.136571) |
Enumeration Date | 2012-05-22 |
Last Update Date | 2021-03-18 |