NPI | 1366914111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 21181) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04752) |
Enumeration Date | 2018-12-18 |
Last Update Date | 2021-04-13 |