NPI | 1982085106 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301119237) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN# 23648) |
Enumeration Date | 2015-06-12 |
Last Update Date | 2021-03-01 |