| NPI | 1275735995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.204120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25260) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2019-08-07 |