| NPI | 1477712321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N0943) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 26421) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-04-21 |