| NPI | 1659394765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 1639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 34426) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-02-12 |