| NPI | 1972519544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N5986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24927) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2024-10-29 |