NPI | 1962030080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM DO2023-1012) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM 390200000X) |
Enumeration Date | 2020-04-01 |
Last Update Date | 2024-07-19 |