| NPI | 1902877012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013017434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 23555) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2018-04-19 |