NPI | 1245212646 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: TX E8990) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX E8990) |
Enumeration Date | 2005-11-19 |
Last Update Date | 2022-02-28 |