NPI | 1952665036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A13698) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Q2402) |
207R00000X Internal Medicine (Licence: FL TPOS216) | |
Enumeration Date | 2012-07-03 |
Last Update Date | 2023-06-05 |