NPI | 1124099007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H7739) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42019) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2020-09-04 |