NPI | 1588891998 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C155199) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 247262) |
Enumeration Date | 2009-06-12 |
Last Update Date | 2018-07-11 |