| NPI | 1548824345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T8646) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7082) |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2023-04-11 |