| NPI | 1831483130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1800) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 28338) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2024-09-27 |