NPI | 1174325559 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172712) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: ZZ ME172712) |
208D00000X General Practice (Licence: ZZ ME172712) | |
Enumeration Date | 2025-03-26 |
Last Update Date | 2025-03-26 |