NPI | 1053772798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP60786444) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 583153) |
Enumeration Date | 2016-03-08 |
Last Update Date | 2018-03-17 |