| NPI | 1073664033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 246721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24935) |
| 207Q00000X Family Medicine (Licence: KS 04-41597) | |
| 208D00000X General Practice (Licence: OK 24935) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-08-10 |