| NPI | 1114210416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27329) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2013-07-22 |