NPI | 1194214874 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME172508) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 31270101) |
207R00000X Internal Medicine (Licence: PA MD475502) | |
Enumeration Date | 2018-05-08 |
Last Update Date | 2025-08-29 |