NPI | 1831186543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX K7478) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7478) |
Enumeration Date | 2005-09-29 |
Last Update Date | 2025-06-12 |