NPI | 1962887943 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148799) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125067872) |
207R00000X Internal Medicine (Licence: TX R9859) | |
Enumeration Date | 2015-07-20 |
Last Update Date | 2021-11-10 |