| NPI | 1316969355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M3356) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24137) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-05-31 |