| NPI | 1093195653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 33232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10303) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2018-06-18 |