| NPI | 1457619371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 6687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11831) |
| 207Q00000X Family Medicine (Licence: OK 5204) | |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2015-09-03 |