| NPI | 1700222189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 32509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408097) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2016-08-17 |