NPI | 1790928232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4939) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 204837) |
Enumeration Date | 2009-04-14 |
Last Update Date | 2013-09-23 |