| NPI | 1891781845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 20374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L5186) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2019-10-09 |