NPI | 1841693728 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 11763976-1205) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 18877) |
Enumeration Date | 2014-10-06 |
Last Update Date | 2020-06-03 |