NPI | 1992062160 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q4956) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 18844) |
Enumeration Date | 2012-04-12 |
Last Update Date | 2021-10-06 |