| NPI | 1467490045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX L9470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29626) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2016-06-14 |