| NPI | 1639101488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 25080) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2014-01-02 |