| NPI | 1528258084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N7079) |
| 207Q00000X Family Medicine (Licence: OK 25853) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2012-07-06 |