NPI | 1639305972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME123307) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036128436) |
Enumeration Date | 2009-06-01 |
Last Update Date | 2024-09-20 |