| NPI | 1285863878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A121432) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 30475) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2014-09-17 |