| NPI | 1629518295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 0124R) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2020-10-16 |