| NPI | 1962998401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 38715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2018013129) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2024-02-03 |