NPI | 1598961864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10033947) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD446466) |
Enumeration Date | 2007-06-25 |
Last Update Date | 2012-07-31 |