| NPI | 1588621874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K8574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20416) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2015-10-20 |