NPI | 1417268780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 171689) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250807) |
207Q00000X Family Medicine (Licence: TX S6745) | |
Enumeration Date | 2010-07-01 |
Last Update Date | 2022-08-10 |