| NPI | 1902185077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX p5672) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2024-06-12 |