| NPI | 1619210622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP61286225) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2023-03-27 |