| NPI | 1275847303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 31349) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10038858) |
| 207Q00000X Family Medicine (Licence: AZ 46721) | |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2016-03-08 |