| NPI | 1184600421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OK 10253) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 10253) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2010-06-29 |