NPI | 1942485289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME102232) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT186819) |
Enumeration Date | 2008-01-06 |
Last Update Date | 2021-08-31 |