NPI | 1710265707 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D88305) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 123754) |
Enumeration Date | 2011-07-26 |
Last Update Date | 2020-05-11 |