| NPI | 1205463767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T7728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7272) |
| 207Q00000X Family Medicine (Licence: FL OS19439) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-09-05 |