| NPI | 1255318234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3769) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M6232) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-03-07 |