NPI | 1649395039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2011-0551) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 46247) |
Enumeration Date | 2007-03-21 |
Last Update Date | 2019-01-11 |