| NPI | 1407207806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM RS2016-0468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34534) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2020-04-21 |