| NPI | 1073648440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 52211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25096) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2009-02-05 |