NPI | 1609874718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: MD D0044741) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0044741) |
207R00000X Internal Medicine (Licence: MD D0044741) | |
Enumeration Date | 2005-07-12 |
Last Update Date | 2017-03-27 |