| NPI | 1407596844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 8963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022025181) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2025-06-13 |