NPI | 1013283449 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10738150-1205) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q4631) |
Enumeration Date | 2012-03-29 |
Last Update Date | 2019-03-21 |