| NPI | 1346239258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F6612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 16349) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OK 16349) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: TX F6612) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2013-09-17 |