| NPI | 1679544787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8328) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20327) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2016-05-20 |