NPI | 1528487907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 67591) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10049496) |
Enumeration Date | 2014-04-14 |
Last Update Date | 2020-07-08 |