NPI | 1407137375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301099664) |
Additional Taxonomies | 261QE0002X Clinic/Center, Emergency Care |
261QP2300X Clinic/Center, Primary Care | |
282E00000X | |
282N00000X General Acute Care Hospital (Licence: MI 4301099664) | |
Enumeration Date | 2011-09-06 |
Last Update Date | 2018-05-17 |