| NPI | 1881180602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 33893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2021-01502) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2026-06-22 |