| NPI | 1861439507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 25302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 115331) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-02-09 |