NPI | 1508811142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0635) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID 0-239) |
Enumeration Date | 2006-05-23 |
Last Update Date | 2019-11-13 |