| NPI | 1518144773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P9000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00049280) |
| 207Q00000X Family Medicine (Licence: KS 04-35033) | |
| 207Q00000X Family Medicine (Licence: OK 30234) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2018-03-21 |