| NPI | 1275558918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR C7758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 36912) |
| 207R00000X Internal Medicine (Licence: CO DR.00655596) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-05-26 |