| NPI | 1194727198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 21767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-6488) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |