| NPI | 1942680913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX S2011) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 31368) |
| 207Q00000X Family Medicine (Licence: OK 31368) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX S2011) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2020-02-12 |