NPI | 1053310078 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MD D0042053) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0042053) |
208D00000X General Practice (Licence: WV 25568) | |
Enumeration Date | 2005-07-20 |
Last Update Date | 2024-01-25 |