NPI | 1871721993 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2949) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL1273) |
Enumeration Date | 2009-06-26 |
Last Update Date | 2015-07-06 |