NPI | 1659987683 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014074) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125075474) |
Enumeration Date | 2020-09-15 |
Last Update Date | 2023-05-11 |