| NPI | 1700837986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 023940) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2022-12-12 |