| NPI | 1811189269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0442440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25886) |
| 207Q00000X Family Medicine (Licence: AR E6737) | |
| 207Q00000X Family Medicine (Licence: CA A132344) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-01-23 |