NPI | 1407125800 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 83563) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 33648) |
Enumeration Date | 2011-12-14 |
Last Update Date | 2020-02-04 |