| NPI | 1932720349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V1914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7421) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-11-12 |