| NPI | 1851917363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U4573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 38396) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2023-10-24 |