NPI | 1912252172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX R7538) |
Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OK 5254) |
Enumeration Date | 2012-07-13 |
Last Update Date | 2023-04-18 |