| NPI | 1538266879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5054123-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29716) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-03-10 |