NPI | 1275572190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: GA 043534) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 043534) |
Enumeration Date | 2006-06-06 |
Last Update Date | 2020-07-06 |