| NPI | 1205350808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 16882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 9562) |
| 207Q00000X Family Medicine (Licence: OK 37500) | |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2021-04-14 |