| NPI | 1104866029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 2481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R3F95) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-12-18 |