| NPI | 1184730806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 42691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35081211F) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2025-09-08 |