NPI | 1639630098 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81215) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-11707) |
208D00000X General Practice (Licence: IA DO-05987) | |
Enumeration Date | 2019-03-28 |
Last Update Date | 2025-08-26 |