NPI | 1568807584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GU M2066) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 019743) |
Enumeration Date | 2013-05-03 |
Last Update Date | 2018-11-14 |