| NPI | 1881826790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 69016-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 28991) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2020-12-31 |