| NPI | 1346479029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S3081) |
| 207Q00000X Family Medicine (Licence: PA OT013135) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2020-12-09 |