NPI | 1548889561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS022579) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4856) |
Enumeration Date | 2020-04-09 |
Last Update Date | 2023-05-07 |