| NPI | 1114535812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2024-0148) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 35876) |
| Enumeration Date | 2020-07-19 |
| Last Update Date | 2024-03-19 |