NPI | 1679573299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M4025) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 18726) |
Enumeration Date | 2005-07-26 |
Last Update Date | 2022-12-06 |