NPI | 1174591887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G9296) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 16804) |
207Q00000X Family Medicine (Licence: IN 01058071A) | |
Enumeration Date | 2006-03-09 |
Last Update Date | 2008-04-11 |