| NPI | 1316949563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3310) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 3310) |
| 208000000X Pediatrics (Licence: OK 3310) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2012-09-27 |