| NPI | 1316905151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 35995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 17169) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-07-08 |