| NPI | 1568826501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 39852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 6358-851) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-09-13 |