| NPI | 1699731091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C5781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 11515) |
| 207Q00000X Family Medicine (Licence: OK 14898) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-01-09 |