NPI | 1609078286 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106081) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 045467) |
207R00000X Internal Medicine (Licence: PA MD434575) | |
Enumeration Date | 2007-06-05 |
Last Update Date | 2021-03-14 |