| NPI | 1033397567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019033337) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4510) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2020-05-15 |