NPI | 1508161811 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 12742) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125058528) |
Enumeration Date | 2011-01-18 |
Last Update Date | 2018-08-08 |