NPI | 1528370368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 73905) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 46216) |
207R00000X Internal Medicine (Licence: FL TRN14646) | |
Enumeration Date | 2010-07-09 |
Last Update Date | 2023-06-19 |