| NPI | 1518144534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M7833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4724) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2022-03-16 |