NPI | 1619469145 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021007722) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09504) |
Enumeration Date | 2018-05-31 |
Last Update Date | 2021-11-28 |