| NPI | 1356347918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-27780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 39901) |
| 207Q00000X Family Medicine (Licence: CO CDR.0000186) | |
| 207Q00000X Family Medicine (Licence: NE 31184) | |
| 207Q00000X Family Medicine (Licence: TX T6793) | |
| 207Q00000X Family Medicine (Licence: MO 2019010639) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2026-02-20 |