NPI | 1538454780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 53891) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041636) |
Enumeration Date | 2011-06-16 |
Last Update Date | 2014-10-02 |