| NPI | 1174010375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011392) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7702) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2025-07-17 |