| NPI | 1881913895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 30712) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OK 30712) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2019-12-02 |