NPI | 1205182508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL DO 1488) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0291A) |
Enumeration Date | 2012-07-24 |
Last Update Date | 2015-10-27 |