NPI | 1639448301 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-066285) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 135783-1) |
207R00000X Internal Medicine (Licence: TX H6814) | |
Enumeration Date | 2011-12-23 |
Last Update Date | 2011-12-23 |