| NPI | 1003823550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 14837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A44838) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-10-09 |