| NPI | 1710138938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 57014431) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35120381) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2016-10-25 |