| NPI | 1376567081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 38659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H4022) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-05-23 |