NPI | 1043414402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q1645) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 31041) |
Enumeration Date | 2007-06-12 |
Last Update Date | 2021-12-02 |