NPI | 1710029582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11956) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036113686) |
207Q00000X Family Medicine (Licence: IN 02002897A) | |
Enumeration Date | 2007-02-12 |
Last Update Date | 2020-09-18 |