NPI | 1093725384 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0993) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081798) |
207Q00000X Family Medicine (Licence: NC 2008-00972) | |
Enumeration Date | 2006-08-09 |
Last Update Date | 2013-04-16 |