| NPI | 1376692285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N1285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24109) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2015-06-15 |