| NPI | 1013173012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 45775) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25792) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2016-07-20 |