NPI | 1083619746 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D6212) |
Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX D6212) |
Enumeration Date | 2005-06-17 |
Last Update Date | 2018-03-17 |