NPI | 1790304871 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM DO2024-0126) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U3047) |
Enumeration Date | 2020-04-09 |
Last Update Date | 2025-03-04 |