NPI | 1518194687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8631872-1205) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60243907) |
Enumeration Date | 2009-06-16 |
Last Update Date | 2021-09-08 |