NPI | 1124256383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R3543) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 27360) |
207R00000X Internal Medicine (Licence: IA 39195) | |
207R00000X Internal Medicine (Licence: IA R8670) | |
Enumeration Date | 2009-06-26 |
Last Update Date | 2018-08-13 |