| NPI | 1962024638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD229191) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 41333) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2026-08-26 |