NPI | 1760725204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 57642) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q8252) |
207Q00000X Family Medicine (Licence: NM MD2015-0161) | |
Enumeration Date | 2013-04-03 |
Last Update Date | 2019-09-23 |