| NPI | 1437463593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0436385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27717) |
| Enumeration Date | 2010-07-31 |
| Last Update Date | 2017-12-15 |