NPI | 1376788117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 49589) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R1758) |
207R00000X Internal Medicine (Licence: KY 44204) | |
Enumeration Date | 2008-12-09 |
Last Update Date | 2024-04-11 |