NPI | 1629430483 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A185074) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 295895) |
Enumeration Date | 2016-03-22 |
Last Update Date | 2023-09-01 |