| NPI | 1336281823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 268065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24693) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2025-09-05 |