NPI | 1114366143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME170893) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt203188) |
207R00000X Internal Medicine (Licence: WA md60800332) | |
Enumeration Date | 2013-06-24 |
Last Update Date | 2025-06-19 |