| NPI | 1598708281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 24183) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IN 01063492A) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-08-21 |