NPI | 1184611592 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 45270) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 42570021) |
Enumeration Date | 2005-09-30 |
Last Update Date | 2011-02-21 |