NPI | 1346651718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16565) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q6529) |
Enumeration Date | 2014-05-19 |
Last Update Date | 2023-12-22 |