NPI | 1063941086 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065517) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10061) |
Enumeration Date | 2017-06-05 |
Last Update Date | 2021-04-07 |