| NPI | 1710909593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 16665) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 16665) |
| 202C00000X Independent Medical Examiner (Licence: OK 16665) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-05-04 |