| NPI | 1487818449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N0680) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-12-03 |