NPI | 1629691845 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 33179) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA MD-54712) |
Enumeration Date | 2020-05-21 |
Last Update Date | 2025-09-03 |