| NPI | 1619956943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3932) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 007531) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2023-08-16 |