NPI | 1780818039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 15962) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 45200) |
207R00000X Internal Medicine (Licence: MI 4301099571) | |
207R00000X Internal Medicine (Licence: MN 1507) | |
Enumeration Date | 2009-05-14 |
Last Update Date | 2011-11-07 |