| NPI | 1053042408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO226364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 0542R) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2025-08-07 |