| NPI | 1104853142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 23398) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 23398) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2023-05-11 |