| NPI | 1134149180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6520) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3474) |
| 207Q00000X Family Medicine (Licence: MO 2020020070) | |
| 208M00000X Hospitalist (Licence: MO 2020020070) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-02-22 |