| NPI | 1265755813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7981) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 27135) |
| 207Q00000X Family Medicine (Licence: OK 27135) | |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2016-11-09 |