| NPI | 1689866725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-6411) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27166) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2022-05-24 |