NPI | 1184980922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX q5412) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73184) |
Enumeration Date | 2012-04-05 |
Last Update Date | 2021-09-17 |