NPI | 1659475028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J0159) |
Additional Taxonomies | 207RS0012X Internal Medicine, Sleep Medicine (Licence: TX 149213) |
332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 149213) | |
Enumeration Date | 2006-09-07 |
Last Update Date | 2019-07-09 |