NPI | 1285259606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD481015) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220153) |
207R00000X Internal Medicine (Licence: GA 14834) | |
Enumeration Date | 2020-06-11 |
Last Update Date | 2024-02-12 |