| NPI | 1639599855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 30738) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 30738) |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2018-06-29 |