| NPI | 1063830263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 33985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017670A) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2018-07-27 |