NPI | 1104063627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1199) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N1199) |
Enumeration Date | 2009-01-21 |
Last Update Date | 2009-07-07 |