| NPI | 1487002556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 32460) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 32460) |
| 207Q00000X Family Medicine (Licence: OK 32460) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-10-17 |