| NPI | 1518980580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25607) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R0950) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-10-22 |