NPI | 1720272859 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112570) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt189510) |
207R00000X Internal Medicine (Licence: IA 38260) | |
Enumeration Date | 2007-08-31 |
Last Update Date | 2020-06-02 |