NPI | 1245855949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20727) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T2699) |
Enumeration Date | 2020-06-09 |
Last Update Date | 2023-08-29 |