| NPI | 1629427430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6217) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 15896) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2019-06-05 |