NPI | 1316327125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156032) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R9299) |
Enumeration Date | 2015-06-05 |
Last Update Date | 2020-07-31 |