NPI | 1043282213 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 46619) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101245618) |
207Q00000X Family Medicine (Licence: WI 68532-20) | |
207Q00000X Family Medicine (Licence: TX K2605) | |
Enumeration Date | 2006-02-02 |
Last Update Date | 2020-09-01 |