NPI | 1811183965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 20582) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 20582) |
Enumeration Date | 2007-09-22 |
Last Update Date | 2013-07-11 |