NPI | 1982964607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015015365) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-38164) |
207R00000X Internal Medicine (Licence: OK 29180) | |
Enumeration Date | 2012-05-29 |
Last Update Date | 2020-10-27 |