| NPI | 1710169446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0068031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 27023) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2024-03-29 |