NPI | 1902483357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: TX V0500) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V0500) |
207R00000X Internal Medicine (Licence: MI 4301510818) | |
208D00000X General Practice (Licence: MI 4301510818) | |
Enumeration Date | 2021-03-24 |
Last Update Date | 2025-03-20 |