NPI | 1316506264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61263771) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074293) |
Enumeration Date | 2019-06-12 |
Last Update Date | 2022-08-31 |