| NPI | 1770567000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 14117) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: OK 14117) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2011-09-29 |