| NPI | 1881783181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 14796) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 14796) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-07-16 |