NPI | 1861665911 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000047416) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 45434) |
Enumeration Date | 2008-04-09 |
Last Update Date | 2012-06-25 |