| NPI | 1912151895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 26627) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 26627) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2018-03-23 |