NPI | 1134407307 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109374) |
Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL 109374) |
Enumeration Date | 2011-07-21 |
Last Update Date | 2017-04-24 |