| NPI | 1548675036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5769) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 5769) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-04-16 |