NPI | 1215264536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME111725) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18208) |
Enumeration Date | 2009-11-06 |
Last Update Date | 2021-07-06 |