| NPI | 1528138633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25600) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A85663) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2011-04-20 |