| NPI | 1740592435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2012008079) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 4950) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2024-06-03 |