| NPI | 1144343096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P7313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4487) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2020-04-21 |