NPI | 1528218880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6034) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10030932) |
Enumeration Date | 2008-09-23 |
Last Update Date | 2016-07-23 |