| NPI | 1144416462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 27073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 249481) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2015-01-08 |