NPI | 1821100504 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01058750A) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 24137) |
207R00000X Internal Medicine (Licence: NC 2012-00404) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2017-01-23 |