| NPI | 1295708428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR R-3454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L4621) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: OK 3902) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-02-16 |