| NPI | 1255747986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 32876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 74620) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2026-08-03 |