| NPI | 1255619268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5080) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2019-06-07 |