| NPI | 1417936337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 14774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 18038) |
| 207Q00000X Family Medicine (Licence: AK 127611) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2020-12-08 |