| NPI | 1083656417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 22433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 7046A) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2016-05-31 |