| NPI | 1831139880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N6775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25828) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2013-02-07 |