| NPI | 1962531723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX j2392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 21060) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-06-25 |