| NPI | 1518014729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR N-8164) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AR N-8164) |
| 208D00000X General Practice (Licence: OK N-8164) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-03-07 |