NPI | 1629645171 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME175452) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 12873) |
Enumeration Date | 2021-06-04 |
Last Update Date | 2025-07-23 |