NPI | 1144225822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F6504) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 83173) |
Enumeration Date | 2005-06-17 |
Last Update Date | 2012-12-20 |