NPI | 1124106869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M5471) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 241569) |
Enumeration Date | 2006-11-01 |
Last Update Date | 2014-05-28 |