| NPI | 1114367216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 49917) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 05-40831) |
| 207P00000X Emergency Medicine (Licence: OK 8749) | |
| 207Q00000X Family Medicine (Licence: MO 2022018701) | |
| 207Q00000X Family Medicine (Licence: OK 8749) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-12-20 |