| NPI | 1750871141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 37903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11109) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2021-08-12 |