| NPI | 1245524941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 29496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10041307) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2020-11-10 |