| NPI | 1326268798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX q0230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23967) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2014-11-04 |