NPI | 1619469772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020415) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018390) |
Enumeration Date | 2018-06-05 |
Last Update Date | 2024-04-30 |