NPI | 1467428680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN TN030909) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6017) |
207Q00000X Family Medicine (Licence: KY 47980) | |
Enumeration Date | 2006-02-27 |
Last Update Date | 2020-06-11 |