| NPI | 1467490235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2009-00664) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2011-02-28 |