| NPI | 1598077679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-8115) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 288945) |
| 207Q00000X Family Medicine (Licence: OK 27769) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2023-07-10 |