| NPI | 1235592809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S4666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 35269) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-02-27 |