NPI | 1598763963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 235065) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K2192) |
Enumeration Date | 2005-07-11 |
Last Update Date | 2023-09-25 |