NPI | 1508895996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6339) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 141512) |
207Q00000X Family Medicine (Licence: OK 23671) | |
Enumeration Date | 2006-06-30 |
Last Update Date | 2025-06-10 |