| NPI | 1154767655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-24246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 04-21442) |
| 207Q00000X Family Medicine (Licence: IN 01066005A) | |
| Enumeration Date | 2013-05-11 |
| Last Update Date | 2013-05-11 |