| NPI | 1295762326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 40182) |
| 207Q00000X Family Medicine (Licence: OK 25149) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2021-11-29 |