NPI | 1265592596 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-00158) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49846-021) |
207Q00000X Family Medicine (Licence: TX N1731) | |
Enumeration Date | 2006-12-08 |
Last Update Date | 2020-10-26 |