NPI | 1962686030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D71459) |
Additional Taxonomies | 122300000X Dentist (Licence: DC den5938) |
122300000X Dentist (Licence: MD 15670) | |
207P00000X Emergency Medicine (Licence: DC MD036903) | |
Enumeration Date | 2007-12-24 |
Last Update Date | 2019-10-25 |