NPI | 1629033402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37458) |
Additional Taxonomies | 208D00000X General Practice (Licence: KY 37458) |
Enumeration Date | 2006-04-18 |
Last Update Date | 2017-02-03 |