| NPI | 1811038581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015043480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 24519) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2018-12-06 |