| NPI | 1841295128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 24537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K8651) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-07-08 |