NPI | 1396127684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R9215) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 063-T1) |
Enumeration Date | 2015-06-23 |
Last Update Date | 2023-02-23 |