| NPI | 1316980139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 057618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23851) |
| 207R00000X Internal Medicine (Licence: OK 23851) | |
| 208M00000X Hospitalist (Licence: GA 057618) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2015-07-30 |