| NPI | 1982692307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 9824877-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 20266) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2017-11-16 |