NPI | 1336175231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9212) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3918) |
Enumeration Date | 2006-06-23 |
Last Update Date | 2018-09-18 |