NPI | 1285860478 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 72257) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3501) |
207Q00000X Family Medicine (Licence: CA 20A15740) | |
Enumeration Date | 2009-06-02 |
Last Update Date | 2024-03-21 |