NPI | 1487639886 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F4324) |
Additional Taxonomies | 208D00000X General Practice (Licence: TX F4324) |
Enumeration Date | 2005-12-08 |
Last Update Date | 2020-05-22 |