NPI | 1972694792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A43091) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J9772) |
Enumeration Date | 2006-09-27 |
Last Update Date | 2020-11-19 |