| NPI | 1922075241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 351797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 3494) |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2026-08-19 |