NPI | 1083915904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7284) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX N7284) |
Enumeration Date | 2010-11-09 |
Last Update Date | 2017-07-17 |