| NPI | 1861527509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 15259) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: OK 15259) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-08-09 |