NPI | 1366782567 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9036325-1204) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12754) |
Enumeration Date | 2013-02-25 |
Last Update Date | 2020-11-30 |