| NPI | 1548358013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-36883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29630) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-06-02 |