NPI | 1043347222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M9783) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3226) |
Enumeration Date | 2007-02-27 |
Last Update Date | 2024-11-19 |