| NPI | 1427083351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K9788) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-10-31 |