NPI | 1023375995 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9118) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 26421) |
Enumeration Date | 2012-04-17 |
Last Update Date | 2022-09-09 |