| NPI | 1346404001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S4344) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2020-05-12 |