| NPI | 1073829560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P3764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5147) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2016-07-26 |