| NPI | 1669663183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M8280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25779) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2008-04-08 |