| NPI | 1073724332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 1680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO0000000175) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2015-08-31 |