| NPI | 1114035334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5797) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2206) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2015-07-24 |