| NPI | 1275503641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M9857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23939) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-03-03 |