| NPI | 1609910959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A105774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24922) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2021-12-06 |