| NPI | 1770546640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 4367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201015) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-06-29 |