| NPI | 1295979136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 26465) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2024-06-26 |