NPI | 1255998761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V5905) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD61283087) |
Enumeration Date | 2019-05-21 |
Last Update Date | 2025-05-19 |