| NPI | 1962840504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 32026) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10046113) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2020-10-30 |