NPI | 1275969941 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q7741) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 19097) |
Enumeration Date | 2013-09-25 |
Last Update Date | 2017-01-10 |