NPI | 1194081414 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.207591) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-9199) |
207Q00000X Family Medicine (Licence: TX Q3727) | |
Enumeration Date | 2012-04-11 |
Last Update Date | 2018-06-10 |