| NPI | 1053811273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S3449) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 6746) |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2024-10-30 |