NPI | 1174861876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C173320) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268957) |
Enumeration Date | 2013-01-30 |
Last Update Date | 2021-08-24 |