| NPI | 1821229089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 28402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP678) |
| 207Q00000X Family Medicine (Licence: MO 2008015412) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2017-07-20 |