| NPI | 1386614758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 23766) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 23766) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2023-04-04 |