| NPI | 1114305828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A163947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34964) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2024-10-31 |