NPI | 1407077928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: KY 03852) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN D0746) |
Enumeration Date | 2007-05-01 |
Last Update Date | 2021-01-21 |