| NPI | 1023085503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD192239) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 23273) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2020-11-23 |