NPI | 1659703395 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-01538) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-01538) |
Enumeration Date | 2013-08-05 |
Last Update Date | 2024-12-24 |