| NPI | 1316682990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 45200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10079238) |
| Enumeration Date | 2022-04-28 |
| Last Update Date | 2025-11-20 |