| NPI | 1982199519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 6656) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 6656) |
| 207Q00000X Family Medicine (Licence: OK 0239R) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2019-10-03 |