NPI | 1356803852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T3323) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 22855) |
Enumeration Date | 2019-04-03 |
Last Update Date | 2025-05-22 |