NPI | 1861667255 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S9771) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 25375) |
207Q00000X Family Medicine (Licence: WA MD60592079) | |
Enumeration Date | 2008-04-25 |
Last Update Date | 2021-08-20 |