| NPI | 1922673243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027732) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 0462R) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2025-12-12 |