| NPI | 1326005190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010019729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4291) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2025-07-10 |