| NPI | 1720651227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 33988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 38218) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2025-06-12 |