NPI | 1245429158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4882) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 2302-850) |
Enumeration Date | 2007-10-16 |
Last Update Date | 2017-12-18 |