NPI | 1962764761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 303676) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10044085) |
207Q00000X Family Medicine (Licence: TX Q1464) | |
Enumeration Date | 2012-06-08 |
Last Update Date | 2018-03-17 |