| NPI | 1285776930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 45237) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4304) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-09-27 |