| NPI | 1841425402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P4575) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27018) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2016-07-14 |