NPI | 1770046633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME159045) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 35727) |
Enumeration Date | 2019-04-08 |
Last Update Date | 2025-09-09 |