| NPI | 1174608319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 18589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 10580) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-11-11 |