NPI | 1073657482 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8898) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T0566) |
Enumeration Date | 2007-02-18 |
Last Update Date | 2022-03-02 |