NPI | 1750373700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J4359) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22412) |
Enumeration Date | 2005-08-16 |
Last Update Date | 2007-10-25 |