| NPI | 1285600262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E4605) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2016-08-30 |