| NPI | 1376584136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 34572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 36209) |
| 207Q00000X Family Medicine (Licence: OK 24223) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-09-05 |