NPI | 1639177959 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ C6206) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K4344) |
Enumeration Date | 2005-07-11 |
Last Update Date | 2013-10-24 |