| NPI | 1013112044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25739) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q2506) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2015-04-28 |