| NPI | 1063641884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 29446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-7555) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2023-07-17 |