| NPI | 1306162979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 8195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012003504) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2023-11-13 |