NPI | 1760879852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A15089) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R6097) |
Enumeration Date | 2015-04-16 |
Last Update Date | 2021-11-10 |