| NPI | 1770220774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 44298) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10078507) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2025-03-31 |