| NPI | 1770998429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 32698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA r-10027) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2022-07-21 |