NPI | 1609086842 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P8795) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 26635) |
Enumeration Date | 2007-05-23 |
Last Update Date | 2022-07-21 |