NPI | 1528621893 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD488658C) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 319275) |
207R00000X Internal Medicine (Licence: DC CS221201029) | |
Enumeration Date | 2019-04-22 |
Last Update Date | 2025-03-31 |