| NPI | 1407065725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T0194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5489) |
| 207Q00000X Family Medicine (Licence: AR E-5244) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-12-07 |