| NPI | 1063705416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 30888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9130) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2025-01-15 |