| NPI | 1184286296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 40329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15846) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-01-21 |