| NPI | 1962470732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 20174) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 20174) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-01-06 |