NPI | 1750375507 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200501470) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200501470) |
Enumeration Date | 2005-09-08 |
Last Update Date | 2021-06-11 |