| NPI | 1013045913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 20836) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: OK 20836) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2025-08-13 |