| NPI | 1144280991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 93772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23821) |
| 207Q00000X Family Medicine (Licence: TX M7864) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2024-09-13 |