NPI | 1962620401 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 055613) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME93723) |
Enumeration Date | 2007-04-22 |
Last Update Date | 2014-02-11 |