NPI | 1003041740 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8252545-1205) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27181) |
Enumeration Date | 2009-05-26 |
Last Update Date | 2024-04-18 |