| NPI | 1982920708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5064) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: OK 5064) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2018-02-09 |