| NPI | 1326496613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 40700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018779A) |
| 207Q00000X Family Medicine (Licence: WI 76604) | |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2023-05-05 |