NPI | 1639832124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-02453) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P112080) |
Enumeration Date | 2021-10-21 |
Last Update Date | 2025-09-24 |