| NPI | 1619955473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 106094) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 106094) |
| 207Q00000X Family Medicine (Licence: OK 24733) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-04-22 |