NPI | 1962423731 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 13112) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX E0524) |
Enumeration Date | 2006-07-21 |
Last Update Date | 2014-12-02 |