| NPI | 1740476951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 29460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10028372) |
| 207Q00000X Family Medicine (Licence: TX N5564) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2013-02-08 |