NPI | 1285194720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME150242) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 39040) |
Enumeration Date | 2019-03-21 |
Last Update Date | 2025-01-16 |