NPI | 1871979732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME141096) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 19152) |
Enumeration Date | 2015-08-03 |
Last Update Date | 2024-01-11 |