| NPI | 1992783948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 11254A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-25758) |
| 207Q00000X Family Medicine (Licence: OK 3103) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2019-11-04 |