| NPI | 1225278914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4858) |
| 207Q00000X Family Medicine (Licence: MO 2019033197) | |
| 207Q00000X Family Medicine (Licence: SC DO32953) | |
| 207Q00000X Family Medicine (Licence: NC 195325) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2020-10-05 |