| NPI | 1922495506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD187718) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 31455) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2018-11-19 |