NPI | 1073967527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME139354) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN22736) |
Enumeration Date | 2016-04-21 |
Last Update Date | 2019-09-23 |