NPI | 1386938165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12685) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q2335) |
207Q00000X Family Medicine (Licence: TN 50570) | |
Enumeration Date | 2011-06-08 |
Last Update Date | 2019-08-08 |