NPI | 1902063373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3540) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N3540) |
Enumeration Date | 2008-05-21 |
Last Update Date | 2024-01-04 |