NPI | 1922539857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152163) |
Additional Taxonomies | 208D00000X General Practice (Licence: GA 081380) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-22 |
Last Update Date | 2023-10-09 |