| NPI | 1760796734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 31222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2016-01958) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2016-12-13 |