NPI | 1689823429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R1957) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.009584) |
207Q00000X Family Medicine (Licence: OH 58.001880) | |
Enumeration Date | 2008-09-17 |
Last Update Date | 2023-02-24 |