NPI | 1629236252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0068012) |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: MD D0068012) |
Enumeration Date | 2008-05-30 |
Last Update Date | 2021-01-08 |