| NPI | 1326307547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29343) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2016-08-18 |