| NPI | 1619369691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 294645) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 35402) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2024-11-11 |