| NPI | 1073741732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 2628026) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-03-24 |