| NPI | 1871589341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1136) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20046) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2023-07-18 |