NPI | 1659528743 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN MD48671) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 46441) |
207Q00000X Family Medicine (Licence: TX BP10030923) | |
Enumeration Date | 2008-08-20 |
Last Update Date | 2023-05-10 |