| NPI | 1245766864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Bp100059390) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2020-07-15 |