NPI | 1629200415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D2854) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX D-2854) |
Enumeration Date | 2009-08-13 |
Last Update Date | 2024-06-10 |