| NPI | 1205337201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T1459) |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2025-08-12 |