| NPI | 1720072358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G3026) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G3026) |
| 207Q00000X Family Medicine (Licence: OK 2290) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-04-11 |