NPI | 1710954854 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 034591) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN009804) |
207R00000X Internal Medicine (Licence: AL 00015943) | |
Enumeration Date | 2006-03-08 |
Last Update Date | 2017-07-31 |