| NPI | 1770991754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-10760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 30635) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-07-21 |