NPI | 1629065776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M3503) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036091613) |
Enumeration Date | 2005-10-04 |
Last Update Date | 2023-03-08 |