| NPI | 1881259091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0068289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34860) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2022-06-08 |