| NPI | 1386605491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR N-6770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 14292) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2022-03-08 |