NPI | 1093795163 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0582) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB05700100) |
Enumeration Date | 2006-01-17 |
Last Update Date | 2013-04-09 |