| NPI | 1710361506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 34667) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U5460) |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2024-03-20 |