NPI | 1396945648 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134729) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M6934) |
207Q00000X Family Medicine (Licence: GA 74268) | |
Enumeration Date | 2007-07-24 |
Last Update Date | 2019-02-27 |