NPI | 1801076898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 32527) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L0938) |
Enumeration Date | 2007-11-07 |
Last Update Date | 2010-11-23 |