| NPI | 1841245024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 19517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K3130) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-09-26 |