NPI | 1275989394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S1116) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10057105) |
Enumeration Date | 2016-05-07 |
Last Update Date | 2022-06-14 |