NPI | 1609812437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME110974) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2549) |
Enumeration Date | 2006-06-21 |
Last Update Date | 2022-02-10 |