| NPI | 1629291836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2015-0267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53217) |
| 207Q00000X Family Medicine (Licence: OK 28688) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-10-09 |