| NPI | 1396184420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 35371) |
| 207Q00000X Family Medicine (Licence: MO 2015014717) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-03-03 |