| NPI | 1104280114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 19989) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 19989) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-06 |