NPI | 1821003591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6509) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35745) |
Enumeration Date | 2006-07-30 |
Last Update Date | 2014-12-05 |