NPI | 1912992140 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101172) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 336072558) |
207Q00000X Family Medicine (Licence: KS T-01043) | |
Enumeration Date | 2005-09-14 |
Last Update Date | 2014-08-29 |