NPI | 1750744629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: AK 190618) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101262988) |
207R00000X Internal Medicine (Licence: TX S4498) | |
Enumeration Date | 2016-03-30 |
Last Update Date | 2022-09-27 |