| NPI | 1912455460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX G3377) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK MEDS2144) |
| 207R00000X Internal Medicine (Licence: OK 24819) | |
| 207R00000X Internal Medicine (Licence: TX G3377) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2021-12-17 |