| NPI | 1124318985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 4921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC DO210012449) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2024-07-22 |