| NPI | 1386257640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A203511) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 50543) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2026-09-08 |